L'alimentazione nell'anziano dal domicilio alla lungodegenza. Etica ed appropriatezza dell'apporto nutrizionale nei percorsi assistenziali. Feeding in the elderly from domicile to long term care. Ethics and appropriateness of nutritional support in care paths.

BACKGROUND: The World Health Organization estimates that the population over the age of 60 is growing steadily and will double by the year 2050. In the elderly there are physiological modifications but incorrect nutrition can produce a state of malnutrition that may result in excessive morbidity and mortality or an alteration in the quality of life. Therefore, the diagnosis and therapy of malnutrition are one of the key moments of elder care. Recovery of at least 5% of body weight can reduce the incidence of morbidity and mortality in institutionalized patients. There are several studies in the literature on the state of malnutrition in the elderly, but no one takes into account all the possible risk factors and variations that may arise in nutritional status prior to entering in long term care and later. OBJECTIVE: To assess the state of nutrition and risk factors for malnutrition of patients at the time of entry into a long-term care. Monitor dietary intake during hospitalization and check for changes in nutritional status at a distance of one month from the beginning of institutionalization. This path is promoted: 1) as a means of improving the quality of care, 2) as a means to optimize the outcome of interventions on patients, 3) to discourage and detect ineffective or dangerous interventions, 4) to improve and ensure the adequacy of care, 5) to identify areas of clinical practice where there is insufficient evidence, 6) to help balance costs and results. MATERIALS AND METHODS: A cohort study was developed on eight long term care in which were the same menu, raw materials and methodologies. The population of study is constituted by the new patients of more than 65 years, males or females indifferently and who have signed informed consent to the processing of their data in anonymous form for statistical purposes. People in enteral nutrition were excluded from the study. The collected data encompasses the characteristics of patients and their conditions at time 0, their eating behavior and conditions after a month in long term care (time 1). Data were extracted from clinical diaries, assessment scales and laboratory examinations. RESULTS: The general characteristics of patients (sex, age, level of instruction and provenance), patient conditions at time 0 and time 1 (general conditions, state consciousness, most frequent pathologies, pharmacotherapy, oral cavity conditions, dysphagia, decubitus lesions, walking, cognitive level -MMSE-), nutritional evaluation at time 0 and time 1 (weight, body mass index, weight variations, use of a diet, use of dietary supplements, malnutrition risk -MUST-) and laboratory examinations evaluation at time 0 and time 1 (hemoglobin, absolute lymphocytes, serum iron, folic acid, vitamin B12, vitamin D, calcium, albumin, total cholesterol, glucose). CONCLUSIONS: On the basis of analyzed data, it is concluded that proper nutrition in older people does not go through the construction of a pyramid process but by the creation of a harmonic gear consisting of doctors, chefs, nutritionists, professional educators, caregivers and institutions.